ปัจจัยที่สัมพันธ์กับโรคติดเชื้อทางเดินหายใจส่วนล่างอย่างรุนแรงจากเชื้อไวรัสอาร์เอสวี ในผู้ป่วยเด็กอายุน้อยกว่า 5 ปี ที่โรงพยาบาลพระนั่งเกล้า

Thitiya  Trisorus

Authors

Thitiya Trisorus Dip. Thai Subsboard of Pediatric Pulmonology and Critical Care, Pediatric Department, Pranangklao hospital

Keywords:

severe respiratory syncytial virus (rsv), lower respiratory tract infection (lrti), severe rsv-lrti, clinical respiratory score (crs)

Abstract

Objective: To investigate risk factors associated with hospitalized severe respiratory syncytial virus lower respiratory tract infection in children under 5 years and to determine the rates of intubation with mechanical ventilation, Heated Humidified High Flow Nasal Cannula (HHFNC) use, pediatric intensive care unit (PICU) admitted, and mortality. Methods: This retrospective analytic cross-sectional study reviewed medical records and electronic databases of hospitalized children diagnosed with RSV-LRTI at Pranangklao Hospital between January 1, 2024 and December 31, 2025. A total of 356 patients were included. Factors associated with severe RSV-LRTI were analyzed using logistic regression analysis. Results: A total of 356 children under five years of age with RSV-LRTI were included. Most patients were male, with a median age of 15.9 months. RSV outbreaks occurred predominantly during the rainy season through early winter. RSV pneumonia was the most common diagnosis 84.3%. Severe RSV-LRTI was identified 21.6% of patients. Respiratory support was required in 59.0% of cases, while PICU admitted occurred in 4.8%. No in-hospital mortality. Factors associated with severe RSV-LRTI included age <3 months (OR_Adj=8.7, 95% CI: 3.3–23.1), Preterm (OR_Adj=3.0, 95%CI: 1.0–9.0), presence of ≥2 underlying diseases (OR_Adj=8.7, 95% CI: 3.1–24.2), family income <10,000 baht/month (OR_Adj=2.9, 95% CI: 1.4–6.1), infiltration in ≥2 locations (OR_Adj=25.6, 95% CI: 9.5–56.1), infiltration and atelectasis (OR_Adj=17.5, 95% CI: 2.7–43.4), and nosocomial infection (OR_Adj=35.5, 95% CI: 13.1–56.3). Clinical respiratory score (CRS) ≥ 6 tended to be a predictor for mechanical ventilation. Conclusion: age <3 months, Preterm, multiple underlying diseases, low socioeconomic status, chest radiographic infiltration in ≥2 locations, infiltration and atelectasis, and nosocomial infection were significant risk factors for severe RSV-LRTI in children under five years. Demographic data, early clinical assessment, CRS, CXR and monitoring are essential to reduce disease severity.

References

Suntarattiwong P, Sojisirikul K, Sitaposa P, Sojisirikul K, Pornpatanangkoon A, Chittaganpitch M, et al. Clinical and epidemiological characteristics of respiratory syncytial virus and influenza virus associated hospitalization in urban Thai infants. J Med Assoc Thai 2011;94(Suppl 3):S164- 71.

Fry AM, Chittaganpitch M, Baggett HC, Peret TC, Dare RK, Sawatwong P, et al. The burden of hospitalized lower respiratory tract infection due to respiratory syncytial virus in rural Thailand. PLoS One 2010;5(11).

Sitthikarnkha P, Uppala R, Niamsanit S, Sutra S, Thepsuthammarat K, Techasatian L, et al. Burden of respiratory syncytial virus related acute lower respiratory tract infection in hospitalized Thai children: a 6-year national data analysis. Children 2022;9(12):1990.

Srisingh K, Khongthongprasert S, Jaturabundit T, Soponwaree N, Klangsombat K, Sriwad C, et al. Risk factors for respiratory syncytial virus (RSV) infection in children under 5 years old with acute lower respiratory tract infection. J Thorac Dis 2025;17(7):4565-75.

Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet 2022;399(10340):2047–64.

พรอำภา บรรจงมณี, อมรรัตน์ โรจน์จรัสไพศาล, อัจฉรา ตั้งสถาพรพงษ์. ระบาดวิทยา อาการและอาการแสดง ปัจจัยเสี่ยงของการติดเชื้อทางเดินหายใจจากเชื้อ respiratory syncytial virus ในเด็กที่เข้ารับการรักษา ณ โรงพยาบาลธรรมศาสตร์เฉลิมพระเกียรติ. ธรรมศาสตร์เวชสาร 2559;16(3):370–8.

Chaiut W, Sapbamrer R, Dacha S, Sudjaritruk T, Malasao R. Epidemiology and associated factors for hospitalization related respiratory syncytial virus infection among children less than 5 years of age in Northern Thailand. J Infect Public Health 2023;16(10):1659–65.

Bunjoungmanee P, Sompoch S, Tangsathapornpong A, Kulalert P. Factors associated with severe respiratory syncytial virus infection among hospitalized children in Thammasat University Hospital. F1000Research 2024;13:231.

Keelapang N, Sunkonkit K. Factors associated with intubation and heated high-flow nasal cannula use in hospitalized respiratory syncytial virus infected children: A single-center retrospective cohort study. PLoS One 2025;20(8).

Lee YI, Peng CC, Chiu NC, Huang DTN, Huang FY, Chi H. Risk factors associated with death in patients with severe respiratory syncytial virus infection. J Microbiol Immunol Infect 2016;49(5):737–42.

Condemi A, Marrali D, Albano C, Linares G, Garbo V, Boncori G, et al. Hospitalizations for respiratory syncytial virus (RSV) in Sicily from 2008 to 2021: clinical features and predictors of severity. Ital J Pediatr 2025;51(1):205.

Dallagiacoma G, Lundholm C, Smew AI, Osvald EC, Vartiainen P, Heinonen S, et al. Risk factors for severe outcomes of respiratory syncytial virus infection in children: a nationwide cohort study in Sweden. Lancet Reg Health Eur 2025;58:101447.

Wang Y, Xiang Y, Jin R, Li B, Feng X, Han Q, et al. Risk factors for severe lower respiratory tract infection among children under 5 years of age hospitalized with respiratory syncytial virus. Eur J Clin Microbiol Infect Dis 2025;44(9):2239–51.

จิรรุจน์ ชมเชย, สุพรรณิการ์ ยานกาย. ลักษณะทางคลินิกของผู้ป่วยเด็กที่มีการติดเชื้อทางเดินหายใจส่วนล่างจากเชื้ออาร์เอสวี ในโรงพยาบาลมหาราชนครราชสีมา. วารสารกุมารเวชศาสตร์ 2564;60(3):219–26.

Trusinska D, Zin ST, Sandoval E, Homaira N, Shi T. Risk factors for poor outcomes in children hospitalized with virus-associated acute lower respiratory infections: a systematic review and meta-analysis. Pediatr Infect Dis J 2024;43(5):467–76.

Manti S, Baraldi E. Learn from international recommendations and experiences of countries that have successfully implemented monoclonal antibody prophylaxis for prevention of RSV infection. Ital J Pediatr 2025;51(1):26.

Sheikh Z, Potter E, Li Y, Cohen RA, Dos Santos G, Bont L, et al. Validity of clinical severity scores for respiratory syncytial virus: a systematic review. J Infect Dis 2024; 229(Suppl 1):S8-S17.

Nayani K, Naeem R, Munir O, Naseer N, Feroze A, Brown N, et al. The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department. BMC Pediatr 2018;18(1):339.

มณีรัตน์ ช่วยเกื้อ. ผลของการใช้แบบประเมินความรุนแรงของภาวะหายใจลำบากต่อความรวดเร็วในการดูแล และความพึงพอใจของบุคลากรในผู้ป่วยเด็กโรคระบบหายใจ. วารสารกุมารเวชศาสตร์ 2568;64(4):78-89.

Saelim K, Thirapaleka B, Ruangnapa K, Prasertsan P, Anuntaseree W. Predictors of high-flow nasal cannula failure in pediatric patients with acute respiratory distress. Clin Exp Pediatr 2022;65(12):595-601.